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Lower bed occupancy linked to lower hospital death rate

Lower bed occupancy also linked to improved four-hour A&E waiting time target performance

Ingrid Torjesen

Friday, 18 September 2015

Lower bed occupancy is linked to a lower hospital death rate and improved performance against the four-hour A&E waiting target, research* published online in Emergency Medicine Journal has found.

The research is an evaluation of efforts made to reduce bed occupancy at Derby Teaching Hospitals NHS Foundation Trust.

Increasing workload prompted the trust to introduce a 90% medical, as opposed to surgical, bed occupancy target in July 2013. This was achieved by introducing senior doctor ward rounds, additional beds in community facilities, and planned use of surgical beds for medical patients.

The researchers looked at medical bed occupancy, death rates and the trust’s performance against the four-hour waiting target between 2012 and 2014 to assess whether the changes had any impact on death rates and the ability to meet the national four-hour waiting target for A&E patients.

A total of 210,510 patients used hospital services between 2012 and 2014, with the monthly average rising from 11,695 before the new target to 12,003 afterwards. Similarly, unplanned admissions rose from an average of 2,986 to 3,263.

Medical bed occupancy fell from 93.7% before the introduction of the new target to 90.2% afterwards. The proportion of weeks that the trust met the four-hour A&E target also rose from 33% to 51.4%.

The death rate was measured by three different indicators: the hospital standardised mortality ratio (HMSR); the summary hospital level mortality indicator (SHMI); and the monthly crude mortality. The new target was associated with a fall in all three indicators of between 4.5% and 4.8%.

The researchers said that several studies in different countries point to a link between overcrowding in the emergency department and poorer patient care/experience.

“The tagline that ‘crowding kills’ is emotive, but important. If our access systems fail and patient harm results then we have a responsibility to monitor and report the data that demonstrates potential causes and associations, such that the profession, healthcare systems, and patients can explore, understand, and improve care,” they said.

In a linked editorial,** Professor Steve Goodacre and Mike Campbell of the University of Sheffield suggest that increased bed availability might have led to less seriously ill patients being admitted who might otherwise have been cared for at home, and although the death rate data were adjusted to take account of influential factors, illness severity was not one of them.

“Measures that reduce bed occupancy (increasing bed and senior doctor availability) use up precious health service resources. If this saves lives, then it may be worthwhile, but if it just increases admissions then resources would be better spent elsewhere,” they said.

* D G Boden, et al. Lowering levels of bed occupancy is associated with decreased in hospital mortality and improved performance on the 4-hour target in a UK District General Hospital. Emerg Med J 2015. DOI: 10.1136/emermed-2014-204479

** Steve Goodacre and Mike Campbell. Lowering bed occupancy: a life-saving intervention? Emerg Med J 2015;0:1. DOI:10.1136/emermed-2015-205255

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